TY - JOUR
T1 - Multicenter Study of Endocarditis After Transcatheter Pulmonary Valve Replacement
AU - McElhinney, Doff B.
AU - Zhang, Yulin
AU - Aboulhosn, Jamil A.
AU - Morray, Brian H.
AU - Biernacka, Elżbieta Katarzyna
AU - Qureshi, Athar M.
AU - Torres, Alejandro J.
AU - Shahanavaz, Shabana
AU - Goldstein, Bryan H.
AU - Cabalka, Allison K.
AU - Bauser-Heaton, Holly
AU - Georgiev, Stanimir
AU - Berger, Felix
AU - Millan-Iturbe, Oscar
AU - Peng, Lynn F.
AU - Armstrong, Aimee K.
AU - Levi, Daniel S.
AU - Fronczak-Jakubczyk, Aneta
AU - Sondergaard, Lars
AU - Anderson, Jason H.
AU - Schranz, Dietmar
AU - Jones, Thomas K.
AU - Cheatham, John P.
AU - Schubert, Stephan
AU - Ewert, Peter
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/8/10
Y1 - 2021/8/10
N2 - Background: Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. Objectives: The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. Methods: The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. Results: Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. Conclusions: The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.
AB - Background: Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. Objectives: The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. Methods: The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. Results: Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. Conclusions: The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.
KW - Ross procedure
KW - congenital heart disease
KW - pulmonary valve
KW - tetralogy of Fallot
KW - transcatheter valve
UR - http://www.scopus.com/inward/record.url?scp=85111068328&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.05.044
DO - 10.1016/j.jacc.2021.05.044
M3 - Article
C2 - 34353535
AN - SCOPUS:85111068328
SN - 0735-1097
VL - 78
SP - 575
EP - 589
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -